Provider Demographics
NPI:1598163321
Name:SHANTEAU, JOYE W (PHD)
Entity Type:Individual
Prefix:
First Name:JOYE
Middle Name:W
Last Name:SHANTEAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WULFF DR
Mailing Address - Street 2:NONE
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4544
Mailing Address - Country:US
Mailing Address - Phone:228-806-3220
Mailing Address - Fax:228-875-4372
Practice Address - Street 1:410 WULFF DR
Practice Address - Street 2:NONE
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4544
Practice Address - Country:US
Practice Address - Phone:228-806-3220
Practice Address - Fax:228-875-4372
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS29-414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical